Faculty Bibliography

PURPOSE: To demonstrate an unusual case of bilateral superior keratectasia complicated by a corneal perforation. METHODS: Case report of idiopathic superior keratectasia with a spontaneous perforation managed by amniotic membrane transplantation. RESULTS: Superior keratectasia was confirmed by a pattern of superior corneal steepening seen on corneal topography and keratometry in the fellow eye. CONCLUSIONS: Although rare, keratectasia with hydrops and a corneal perforation may present superiorly, and an amniotic membrane should be considered for management.

The absence of circadian zeitgebers in the social environment causes circadian misalignment, which is often associated with sleep disturbances. Circadian misalignment, defined as a mismatch between the sleep-wake cycle and the timing of the circadian system, can occur either because of inadequate exposure to the light-dark cycle, the most important synchronizer of the circadian system, or reduction in light transmission resulting from ophthalmic diseases (e.g., senile miosis, cataract, diabetic retinopathy, macular degeneration, retinitis pigmentosa, and glaucoma). We propose that glaucoma may be the primary ocular disease that directly compromises photic input to the circadian time-keeping system because of inherent ganglion cell death. Glaucomatous damage to the ganglion cell layer might be particularly harmful to melanopsin. According to histologic and circadian data, a subset of intrinsically photoresponsive retinal ganglion cells, expressing melanopsin and cryptochromes, entrain the endogenous circadian system via transduction of photic input to the thalamus, projecting either to the suprachiasmatic nucleus or the lateral geniculate nucleus. Glaucoma provides a unique opportunity to explore whether in fact light transmission to the circadian system is compromised as a result of ganglion cell loss.

BACKGROUND: The purpose of the present study was to determine the effectiveness of software in the hand-held photofluorometer permitting the monitoring of a second fluorescent signal to improve a contact lens glucose sensor for the non-invasive monitoring of glucose. METHODS: One fasting normal patient was given an oral challenge consisting of 75 mL of Sustacol (Thomson Micromedex, Greenwood, CO). The two contact lens fluorescent signals and fingerstick blood glucose were measured over a 3-h period. RESULTS: Subtracting the second fluorescent signal from the main signal produced a product that appeared to track blood glucose well. The contact lens was comfortable and well tolerated. CONCLUSION: The biwavelength contact lens glucose sensor shows promise as a non-invasive home glucose monitor.

BACKGROUND: Ocular pathology lessens light's efficacy to maintain optimal circadian entrainment. We examined whether ophthalmic dysfunction explains unique variance in melatonin excretion of older adults over and above the variance explained by daily illumination, medical, and sociodemographic factors. We also examined whether ophthalmic dysfunction influences relationships between ambient illumination and melatonin. METHODS: Thirty older adults (mean age = 69 years; Blacks = 42% and Whites = 58%) of both genders participated in the study. Demographic and health data were collected at baseline. Participants underwent eye exams at SUNY Downstate Medical Center, wore an actigraph to monitor illumination and sleep, and collected urine specimens to estimate aMT6s concentrations. RESULTS: Hierarchical regression analysis showed that illumination factors explained 29% of the variance in aMT6s mesor. The proportion of variance explained by ophthalmic factors, sleep duration, and race was 10%, 2%, and 2%, respectively. Illumination factors explained 19% of the variance in aMT6s acrophase. The proportion of variance explained by ophthalmic factors, sleep duration, and race was 11%; 17%; and 2%, respectively. Controlling for sleep duration and race reduced the correlations between illumination and melatonin, whereas controlling for ophthalmic factors did not. CONCLUSION: Ophthalmic exams showed that elevated intraocular pressure and large cup-to-disk ratios were independently associated with earlier melatonin timing. Lower illumination exposure also had independent associations with earlier melatonin timing. Conceivably, ophthalmic and illumination factors might have an additive effect on the timing of melatonin excretion, which in turn might predispose individuals to experience early morning awakenings.

PURPOSE: To describe a rare case of epidermolysis bullosa (EB) and its ocular manifestations. METHOD: A case report. RESULTS: The ocular and systemic findings in this dermatologic condition are presented. CONCLUSIONS: The various presentations of EB are discussed. The management requires close observation and treatment by both ophthalmology and dermatology. Unfortunately in this case the patient was brought to this country after maturation of the visual system with a resultant poor visual outcome.

PURPOSE: To present a case of anterior scarring in an epikeratophakia lenticule and its partially successful treatment with the excimer laser. METHODS: Excimer laser phototherapeutic keratectomy (PTK) was used to reduce corneal scarring in an epikeratophakia lenticule. RESULTS: Visual acuity improved after two sessions of PTK. CONCLUSIONS: PTK is an alternative to epikeratophakia lenticule removal

PURPOSE: To describe an unusual case of cicatrizing conjunctivitis. METHODS AND RESULTS: A 59 year old male presented in July 1997 with a complaint of intermittent redness and discharge of the right eye. Medical history was significant for a buccal mucosal lesion biopsy taken two years earlier that revealed subepidermal fibrosis. Conjunctival biopsy, performed to rule out ocular cicatricial pemphigoid, yielded a diagnosis of linear IgA dermatosis, an unusual diagnosis not often considered by ophthalmologists. CONCLUSIONS: The diagnosis of cicatrizing conjunctivitis is often overlooked. Its importance as it pertains to the life threatening disease of ocular cicatricial pemphigoid is clear.